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*03869708*
REQUEST FOR ELECTRICAL lNSPECTION <��,,
Minnesota State Board of Electricity � °'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ��"�°��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back ot fhe white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspeciion Fee - This lns,oection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 1rJ. g0
Alarm/Remote Control
Swimming Pool I hereby ceriiiy that I inspected the efeetrical installation described herein on the dates stated
irrigation Boom Rough-In Date
peciall f • F� o q
Investigative Fee 'f /^-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTJiS.
X
^ OFFICE USE ONLY This request void 18 � from validation da�printed i�is box.
386-97(�6 , s
�i�
JOB NUMBER #970600
PLEASE PRINT OR TYPE
Request Da�g f 14 � gg Rough-in inspection required? ❑ Yes ❑ No�{ Inspection Other Than Rough-In: � 1}�ady Now Q Will Call
(You must call the inspector when ready) Date Ready: 8/ 1 t� I 98
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
05201 BUCHANAN ST NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Occupant Phone No.
JOAH K PAGLIOLO 571-1931
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Comparry Name1 Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER E[.ECTRIC C0. IHC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
Authorized Sign r( ntractor or Owner Performing Installati Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY